Once-daily telmisartan compared with enalapril in the treatment of hypertension

Abstract

This multicenter, randomized, parallel-group study, which included 440 patients with mild to moderate hypertension, compared the efficacy and safety of various doses of telmisartan, a specific AT 1-receptor antagonist, with those of enalapril and placebo. Following a 4-week placebo run-in period, eligible patients received one of six treatments: telmisartan 40 mg (n = 72), 80 mg (n = 72), 120 mg (n = 73), or 160 mg (n = 75); placebo (n = 76); or enalapril 20 mg (n = 72). Baseline blood pressure, determined at the end of the placebo run-in, was compared with trough blood pressure during the 12 weeks of therapy. All doses of once-daily telmisartan and enalapril significantly (P <90 mm Hg), with nearly maximal effects by week 4. Compared with enalapril, DBP reductions observed at week 12 either approached or achieved statistical significance for telmisartan 40 mg (P = .08) and 80 mg (P = .03), as did SBP reductions for telmisartan 40 mg (P = .06), 80 mg (P = .01), 120 mg (P = .08), and 160 mg (P = .04). The percentage of patients with treatment- related adverse events was somewhat lower for telmisartan (7.5%) than for either enalapril (13.9%) or placebo (10.5%). Incidences of treatment-related cough were 4.2% with enalapril, 0.3% with telmisartan, and 1.3% with placebo. One enalapril-treated patient experienced angioedema. The antihypertensive efficacy of telmisartan was at least comparable to that of enalapril, with tolerability similar to that of placebo.